Continuing conservative management without dialysis is an alternative option for elderly patients. The Japanese Society of Nephrology (JSN) The JSN has published the ‘Clinical Practice Guidebook for Diagnosis and Treatment of Chronic Kidney Disease’ in 2007, 2009, and 2012 [50]. The “Evidence-based Practice Guideline for the treatment of CKD” was published in 2009 and will be updated in 2013 [51]. The JSN has been raising awareness of CKD on World Kidney Day, which is on the second Thursday in March. Importantly, Japanese patients PRIMA-1MET in vivo generally have a lower eGFR compared to American patients. Therefore, an eGFR ≥60 ml/min/1.73 m2 is considered to be normal for someone who is otherwise healthy. Albuminuria

can only be measured and reimbursed for patients with early-stage diabetic kidney disease in Japan. Instead, the JSN advocates using dipstick proteinuria or measuring the daily amount of proteinuria. The JSN has been supporting the research project ‘Frontier of Renal Outcome Modifications in Japan’ (FROM-J) [52]. To prevent or halt CKD and ESKD, general practitioners and medical staff, such as dieticians and public health nurses, must be involved. The JSN referral criteria

for nephrologists were published to facilitate comprehensive care for CKD patients (Table 3) [50]. Additionally, the Asian Forum of CKD Initiatives (AFCKDI) IWR-1 cell line was started to exchange information on CKD at the inaugural 50th JSN meeting in Hamamatsu in 2007. Table 3 JSN criteria for referring CKD patients to a nephrologist (cited from ref. [50]) Proteinuria (≥2+ by dipstick proteinuria) Combined proteinuria and hematuria (both 1+ and over by dipstick proteinuria) Low eGFR (<50 ml/min/1.73 m2): <60 ml/min/1.73 m2 (if age

<40 years) and <40 ml/min/1.73 m2 (if age ≥70 years) Since 2008, the special health check system (so-called Tokutei-Kenshin) has been used to detect subjects with metabolic syndrome and direct them towards a healthy lifestyle. The target population is the 40–74 year age group. The new ‘Kidney Disease: Global Outcomes Improving Outcomes’ (KDIGO) CKD classification prevalence of hypertension was clearly dependent on eGFR and proteinuria (Fig. 6) [53]. Similarly, the prevalence of CVD was dependent on both eGFR and proteinuria. Thus, the JSN is negotiating for Etofibrate a better screening system for CKD in Japan. The JSN has launched web-based registries for CKD and kidney biopsy recipients [54, 55]. Several other research projects are currently being conducted. Fig. 6 Prevalence of hypertension based on the new KDIGO CKD classification (cited from ref. [53]) Kidney Disease: Global Outcomes Improving Outcomes Since the introduction of the concept of CKD, the definition has been challenged with several criticisms: (1) the classification was too simple, (2) lack of key outcomes of CKD, and (3) significance of testing eGFR and check details Albuminuria.